A survey of hospital ambulatory dental programs in Massachusetts Part 1: an overview

A mail survey of ambulatory dental programs at all 123 short-stay hospitals in Massachusetts was conducted for the 1980 fiscal year. The major findings were as follows. Of the 122 responding hospitals, 105 (86%) reported having ambulatory dental visits, 2 1 (20%) of which had dental clinics. The remaining 84 (80%) hospitals provided dental care in surgical day care units, emergency rooms, or both, as did most hospitals with dental clinics. The 177,93 1 reported hospital ambulatory dental visits accounted for approximately 1.6% ambulatory dental visits in all settings, statewide. Approximately 69% of hospital ambulatory dental visits statewide took place in the 21 dental clinics, 21% in surgical day care units, and 10% in emergency rooms. Approxi- mately 66% of dental clinic visits were for gen- era1 dental care and represented less than 1% of ambulatory dental visits in all settings, statewide. Most hospitals with dental clinics were con- centrated in major urban centers. Hospitals in the Greater Boston area accounted for 75% of all ambulatory dental visits and 87% of dental clinic visits, statewide. To properly assess the hospital's role as a dental care resource to a community, general dental care services in community hospital dental clinics should be distinguished from other types of hospital dental care. Our study accomplished this by categorizing ambulatory dental visits according to the types of services provided, the types of hospitals at which they were provided, and the hospital settings in which they were provided. The data suggest that the significance of hospital ambulatory dental programs is not in the amount of dental care that they provide statewide but the types of services offered and their importance to dentally underserved inner city communities.     

Oral health of psychiatric patients: the nurse's perspective

To cite this article:
Int J Dent Hygiene 10 , 2012; 245–249
DOI: 10.1111/j.1601‐5037.2011.00537.x Azodo CC, Ezeja EB, Omoaregba JO, James BO. Oral health of psychiatric patients: the nurse’s perspective. Abstract: Objective: To assess nurses’ perspectives on character, prevalence and cause of oral diseases among psychiatric patients and also their approach and suggestions in relation to the care of oral problems. Materials and Methods: A questionnaire‐based cross‐sectional survey of all cadres of nurses (n = 136) at the Federal Psychiatric Hospital, Benin City, Nigeria, was conducted between December 2010 and January 2011. Results: Two‐thirds (67.6%) of the respondents reported that psychiatric in‐patients in comparison with the general population have a higher occurrence of oral and dental problems. Commonly cited reasons for the poor oral health of patients included as follows: sedation for long periods, lack of care by family, psychopathological symptoms, poor access to dentists and lack of oral hygiene advice. The common oral health complaints received by the respondents included toothache, pain from the gums and inability to open the mouth. Majority (91.4%) of respondents claimed to be presently involved with oral care of psychiatric in‐patients but oral care delivery is however bedevilled with lot of barriers like uncooperativeness of patients and lack of oral care materials. Conclusion: Oral complaints received are frequent and numerate with limited palliative action rendered. Attaching dentists to psychiatric hospitals and regular training of psychiatric nurses on oral care delivery are recommended to comprehensively cater for the oral health problems of psychiatric in‐patients.     

Oral health status, treatment needs, and obstacles to dental care among noninstitutionalized children with severe mental disabilities in The Netherlands

The objective of this study was to assess the oral health status, treatment needs, and barriers to dental care of noninstitutionalized children in The Netherlands who have severe disabilities. The oral health status of 61 children (38% female; 4-12 years of age; M = 7.7, SD = 2.2), randomly selected from seven different daycare centers, was evaluated. Caretakers (n = 126) and dentists (n = 40) completed questionnaires concerning demographic information, oral hygiene, frequency of dental visits, and possible barriers to the daily oral care of the children. Of all the children, 57.4% had untreated caries (mean dmft/DMFT = 3.0; SD = 3.1). The proportion of caries-free children was 29.5%. In comparison to Dutch children, a significantly higher proportion of children with disabilities belonging to an ethnic minority did not receive any routine dental care (53.1% and 23.8%, respectively). Caretakers considered the noncooperation of their patients as the most troublesome aspect of their daily oral care (68%). Dentists considered communication problems as the most important barrier to treatment (75%). In conclusion, Dutch noninstitu-tionalized children with severe disabilities still receive a relatively low degree of quality dental care. This is particularly true for children from ethnic minority groups.     

Oral complications in pediatric oncology patients.

This study investigated the oral problems occurring in children receiving treatment for malignant disease at a regional oncology center. Forty-three children 2 to 14 years old were followed longitudinally from initial diagnosis for periods ranging from eight to 30 weeks for the development of oral and dental problems. Fifteen children had untreated decay; two required the removal of primary teeth before they began chemotherapy. Three children developed acute dental infections during treatment. Forty (93%) developed oral problems associated with their disease or treatment during the study period. Oral mucosal ulceration was the most frequently encountered problem; it was observed in 28 (65%) patients. In light of the high prevalence of dental and oral problems in these patients, this study emphasizes the need for positive dental involvement, both in pretreatment assessment and in the ongoing care of the pediatric oncology patient.     

Dental status of patients with mental disorders in a Nigerian teaching hospital: a preliminary survey

Although individuals with mental disorders are reported to experience dental problems similar to the general population, evidence suggests they actually have higher risks of dental disease and increased oral health needs. This study describes the dental status of 105 psychiatric outpatients in a Nigerian hospital. Information was obtained from subject interviews, medical records, and an oral examination to determine their dental caries and periodontal disease status. The oral hygiene status of the study participants was poor; the mean oral hygiene index score was 2.7 ± 1.20. The decayed, missing, and filled teeth ranged from 0 to 9 with a mean of 2.3 ± 2.28. Only five subjects (4.9%) had restorations and the mean number of filled teeth was .14 ± .67. The subjects’ age was significantly related to the mean oral hygiene score (p= .005), the mean gingival score (p= .006), and caries occurrence (p= .047). The oral health status of psychiatric patients in Nigeria is poor, indicating the need to provide oral health education and increase access to dental care for these patients.     

P43 Effectiveness of a mechanic-chemical method in reducing malodor of dentures

The purpose of this study was to investigate subjective symptoms about oral malodor and the knowledge and attitude for bad breath on dental students. The subjects were 213 students from 1st to 6th year undergraduate course of one dental school in Thailand (male: 70, female: 143). Their mean (s.d.) age was 21.0 (1.9). Questionnaire survey was conducted in November 2003. Questionnaire items were subjective symptoms about oral malodor and dry mouth, the knowledge and attitude for bad breath, oral hygiene practice, smoking/drinking habits, and life stress. Five students (2.3%) answered that they concerned their oral malodor often and 87.8% reported sometimes. Of them, 72.9% wanted to receive treatment for their malodor and 70.8% said they suffer from bad breath in daily life. Two-thirds of students perceived strong oral malodor when waking up. There were no significant differences of the self-perceived malodor rates between gender or among year of study. More than half of the students did not know that oral diseases and poor oral hygiene are the major causes of bad breath. The students' attitudes for bad breath were different if the target was family members or friends. The majority of the students (88.7%) answered they perceived dry mouth. Perception of dry mouth was significantly related with self-reported oral malodor prevalence ( P  < 0.05). However other oral or behavioral factors did not relate to the self-reported malodor rates. In this study, dental students perceived bad breath in high prevalence. However the knowledge for bad breath was not enough even the students who already provided dental treatment to the patients. It would be necessary to give them adequate knowledge and methods in education program for managing not only patients' but also their own oral malodor problem.     

P42 Subjective symptoms and knowledge of oral malodor on dental students in Thailand

The purpose of this study was to investigate subjective symptoms about oral malodor and the knowledge and attitude for bad breath on dental students. The subjects were 213 students from 1st to 6th year undergraduate course of one dental school in Thailand (male: 70, female: 143). Their mean (s.d.) age was 21.0 (1.9). Questionnaire survey was conducted in November 2003. Questionnaire items were subjective symptoms about oral malodor and dry mouth, the knowledge and attitude for bad breath, oral hygiene practice, smoking/drinking habits, and life stress. Five students (2.3%) answered that they concerned their oral malodor often and 87.8% reported sometimes. Of them, 72.9% wanted to receive treatment for their malodor and 70.8% said they suffer from bad breath in daily life. Two‐thirds of students perceived strong oral malodor when waking up. There were no significant differences of the self‐perceived malodor rates between gender or among year of study. More than half of the students did not know that oral diseases and poor oral hygiene are the major causes of bad breath. The students’ attitudes for bad breath were different if the target was family members or friends. The majority of the students (88.7%) answered they perceived dry mouth. Perception of dry mouth was significantly related with self‐reported oral malodor prevalence (P < 0.05). However other oral or behavioral factors did not relate to the self‐reported malodor rates. In this study, dental students perceived bad breath in high prevalence. However the knowledge for bad breath was not enough even the students who already provided dental treatment to the patients. It would be necessary to give them adequate knowledge and methods in education program for managing not only patients’ but also their own oral malodor problem.     

Oral hygiene and oral symptoms among the elderly in long-term care

Dental teams examined 1,910 elderly adults living in long-term care settings (1,358 institutionalized, 552 home-bound) from all 19 counties in Norway to document oral hygiene, oral symptoms and ability to receive dental treatment. The Mucosal-Plaque Score (MPS) was used to assess oral status. The MPS was significantly better in women than in men, in individuals with dentures than in those with any remaining teeth, and in people who were homebound rather than those who lived in institutions. The MPS did not differ between age groups or geographic regions. According to the Treatment Ability Index, nearly a quarter of the sample was able to receive comprehensive dental care. Reports of "any oral symptom" and "eating/chewing problems" decreased with age and were most prevalent for individuals who had dentures. The MPS had only slight impact on oral symptoms, chewing ability and dry mouth ( p > 0.05). Dry mouth was found in 16.9% and was most prevalent in individuals with dentures.     

Workforce requirements for a primary oral health care system

AIM: To present the case for a primary health care (PHC) approach for dental care in Vietnam, and thereby contribute to a better understanding of the oral health problems that exist in many developing countries. METHODS: Information was obtained in Vietnam through discussions with dental and medical authorities of provincial health offices, educational institutions, hospitals, health centres and schools and by collecting data from record books and reports. FINDINGS: Dentistry lacks a PHC strategy and consequently urgent oral care and oral disease prevention and control are not available for the majority of the population in Vietnam. The curriculum of dental students and dental auxiliaries is not adequately directed to the oral health needs of the population. The present number of dental personnel is too low. CONCLUSION: A basic oral health care package (BOHCP) advocated by the WHO which could be incorporated into primary health services at sub-district level and in the school dental service would be most suitable to meet the oral health needs of the population in Vietnam. The oral health education component of the BOHCP may have more impact when it is conducted in close collaboration with non-dental health personnel and lay persons. The curriculum of dental personnel should be adjusted to meet the requirements of their future tasks. Dental auxiliaries, provided they are well trained can carry out the BOHCP. Consequently, there is a large need for this type of dental personnel in Vietnam.     

A survey on dental care and oral implantology in Beijing, China

In this article,we present a survey on dental care and oral implantology in Beijing, China. The Chinese population comprises 1.2 billion or about 20% of the world's population. This survey shows: (i) there is a well‐developed dental system in China, mostly operated by the Chinese government; (ii) in Beijing, there are 1328 dentists and oral surgeons and 515 special dental nurses working in dental departments of hospitals: (iii) about 2 million new patients visit the dentist every year; (iv) oral implantology is a new technology for the Chinese dentist and oral surgeon, as shown by the finding that in 1992, only 384 persons were treated with oral implants in a few hospitals in Beijing; however, most hospitals are interested in performing oral implantology in the near future; (v) imported implants are too expensive for Chinese patients, and therefore good qualified domestic implants and cheaper imported implants have a great market potential.     

Attitudes to and perceptions of oral health and oral care among community-dwelling elderly residents of Stockholm, Sweden: an interview study

The aim of this study was to document perceptions of oral health of community-dwelling elderly people and how it had been affected through life. Twelve individuals (mean age 78.2 years) were gradually recruited to an interview study. The interviews were conducted as conversations, and the topics in a guide model were introduced only if they did not arise spontaneously. The interviews lasted 60-90 min and were tape-recorded and transcribed verbatim and analysed by the phenomenological-hermeneutic method. The interviews dealt with perceptions of growing old, life style, general health, former dental experiences, dental care in adult life, current oral health, general medical care, dental care, oral hygiene, dental hygienist care and the level of participation in treatment decisions. The interviewees were generally satisfied with their present oral health and often referred to their parents' oral problems as deterrents. Dental experiences from childhood, in association with the welfare state and personal financial security, were factors which influenced attitudes and perceptions of oral health and oral care. Although dental care was regarded as very expensive, it had been given priority over other expenses in adult life. The results confirm that the dental hygienist must take into account the importance of oral health to well being in old age and be aware that in elderly people, perception of personal oral health is multifactorial, influenced by life-long experience.     

Oral health behaviour of 12-year-old children in Kuwait

Objectives . The objectives of the study were: (1) to describe the pattern of oral health behaviour of 12-year-old children in Kuwait, (2) to analyse this in relation to parental education, dental visiting habits and location, and (3) to establish a baseline for planning and evaluation of an oral health care programme for secondary schoolchildren.
Design . Cross-sectional, interviews with children in 1995.
Sample and methods . The sample included 500 12-year-old schoolchildren (250 boys and 250 girls) selected from schools in Kuwait. All the children agreed to take part. Interviews with the children were carried out in the schools by four trained and calibrated Arabic speaking interviewers.
Results . During the previous 12 months, 28% of the children had experienced oral health problems – toothache (10%), or had felt discomfort (18%) either often or occassionally. The children reported that they needed oral hygiene instruction (71%), fillings (32%) and tooth extraction (23%). For 53% of the children the reason for the most recent visit to a dentist was pain or problems with teeth or gums. At their last dental visit 26% of the children had undergone a tooth extraction. The consumption of sugary foods and drinks was extremely high. Children who had visited a dentist within the last 12 months and children whose parents had higher education levels more often claimed frequent toothbrushing than those with no previous dental visiting experience and those whose parents had a low level of education.
Conclusions . Oral health education and oral health care programmes should be established in secondary schools in Kuwait to influence the oral health behaviour of the children and to avoid further deterioration in their oral health.     

Self perceived oral health, oral treatment need and the use of oral health care of the adult population in Skåne, Sweden

The aim was to describe how the adult population in Sk?ne, Sweden, perceived their oral health, dental status, oral treatment need and use of oral health care. A questionnaire was sent to a randomly selected sample of 10 000 persons in Sk?ne, Sweden. The individuals were between 20 and 89 years old and registered as residents of the region during 2006. After excluding those no longer living in the region, 9 690 individuals remained. The response rate to the questionnaire was 63%, of which 57% were women and 43% men.A majority was satisfied with their teeth and with their teeth's appearance, 65% and 62% respectively. Of the respondents, 35% considered their dental health to be better than others in their age group. Symptoms associated with periodontitis were experienced by 40%. 7% were missing more than ten teeth while 7% had no dental fillings. 30% rated their need of dental treatment as high and most expected their treatment need to increase in the future. Most of the respondents, 60%, received their oral care at a private practice, whereas 13% did not see a dentist regularly for check-ups. More women than men perceived a high dental treatment need, 32% compared to 28%. CONCLUSIONS: A majority of the adult population in Sk?ne have a positive attitude towards their oral health. Most individuals had lost few teeth and removable dentures were uncommon.A third rated their dental treatment need as high and most expected their treatment need to increase in the future..     

Opinions on the provision of dental care in Iowa nursing homes

Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three‐quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentist's preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on‐site at Iowa nursing homes.     

Oral disease in the elderly in long-term hospital care

OBJECTIVE: To obtain baseline information on the prevalence of oral problems and disease in institutionalized elderly in a Scottish hospital.
DESIGN: A cross-sectional clinical investigation with complementary microbiological studies as appropriate. SUBJECTS AND METHODS: A cohort of 147 elderly in five long-term care wards; collection of demographic data; clinical examination to determine: i) the dental, and denture status and associated lesions such as Candida-associated denture stomatitis and angular cheilitis, ii) oral mucosal disease; swabs as appropriate for microbiology.
MAIN OUTCOME MEASURES: Dental status, root caries prevalence; denture status and hygiene, and associated disease; oral mucosal health.
RESULTS Median period of institutionalization of 147 patients was 15 months and 65% were aged 80 years or more; the majority were significantly mentally impaired; 52% wore complete dentures, 9% were partially dentate, 19% possessed partial or incomplete dentures; 20% were neither dentate nor had dentures. Of 80 patients who verbalired their complaints, 35% complained of dry mouth and 45% had denture-related problems, principally discomfort. The commonest oral finding was a coated tongue (56%); angular cheilitis was present in 25%, and Candida-associated denture stomatitis in 19%; none had oral ulcers.
CONCLUSIONS: There was considerable unmet dental need with significant oral disease and poor levels of oral and denture hygiene in this target group; both dental and medical professionals should act in concert to deliver curative as well as preventative dental care for the elderly living in institutions to improve their quality of life.     

Factors associated with reported need for dental care among people who are homeless using assistance programs

A retrospective secondary data analysis of the National Survey of Homeless Assistance Providers and Clients database was conducted to identify the demographic characteristics and correlates associated with reported need for dental care among people who are homeless in the United States. Overall, 10% of people who were homeless reported that dental care was their most needed service. Of these, 17% had a dental visit within the previous 12 months, 52% were racial/ethnic minorities, 76% lived in a central city, and 26% were veterans. The unadjusted odds for reporting a need for dental care was highest among veterans who were homeless and those whose last dental visit occurred more than 12 months ago. Compared to nonveterans who were homeless, veterans had twice the adjusted odds for reporting a need for dental care. The adjusted odds for reporting a need for dental care were lowest for those with dental insurance. Evaluation of the data suggests that dental insurance was associated with reporting lower need for dental care. Veterans who were homeless reported higher odds for dental care. Strengthening existing oral health‐care programs sensitive to the needs of people who are homeless may improve their oral health and reduce their dental‐disease‐related morbidity.     

Institutional barriers to providing oral health services for underserved populations in New York City

Objectives : We sought to explore institutional barriers to the provision of oral health services for the underserved among inner-city health centers. Methods : Mail-based survey of Medicaid-approved health centers in New York City without oral health services. The importance of four barrier categories was rated: resource issues, dental provider difficulties, referral problems, and low priority of dental care. Results : 36 health centers completed the survey. The most important barriers were resource issues (66.7% agreed), dental provider difficulties (29.4%), referral problems (24.2%), and low priority (15.2%). Top individual barriers were lack of start-up funds (88%), lack of physical space (74%), lack of available funding sources (71%), and low reimbursement rates for dental services (69%). Most centers (78%) identified a need for dental services for their patients. Conclusions : Access to oral health care remains a large problem for the underserved. Institutional barriers will need to be addressed to close the gap.